EMBOLISM OF SUPERIOR MESENTERIC ARTERY AS A COMPLICATION OF CORONARY ANGIOPLASTY SOLVED BY LOCAL THROMBOLYSIS – CASE REPORT

Introduction: Arterial embolism into splanchnic bloodstream may be a potential complication of acute coronarography and primary coronary intervention (PCI).Mortality of such an event depends on early diagnosis and treatment – may be low (without infarsation of affected tissue) as well as reach 70-90%.
Case report: 59-year-old man with diabetes mellitus, severe hyperlipidaemia and gouty arthritis, was admitted to the coronary unit with acute inferolateral cardiac infarction with ST elevation, delay 10hours, Killip I.A successful PCI with stent implantation in a.coronaria dx. was performed. Minutes after the intervention,the patient complained of severe pain in epi- and right hypogastrium. As the pain was worsening, we thought of arterial embolism as well. On urgent contrast CT examination of stomach we found a mural infrarenal thrombus in aorta and defects of bloodflow in superior mesenteric artery (SMA). Having consulted a surgeon and an invasive radiologist, we performed a local thrombolysis of SMA branches using alteplase (Actilyse) 30mg fractionally injected with an arterial catheter.There was an immediate relief of the patient’s pain. Continual infusion with dalteparin (Fragmin) followed. The patient’s state was favourable then – rehabilitation, food tolerance, no marks of infarsation. Control Duplex examinaton of SMA detected normal arterial bloodflow. Patient was dismissed the 9th day of hospitalisation.
Conclusion: Our case report demonstrates the necessity to consider an extracardiac tromboembolic event when acute stomach pain occurs, especially following arterial catheterisation. It is important to manage extended examination – duplex sonography, contrast CT or CT angiography, eventually direct angiography. Early diagnosed cases may be solved with invasive radiological techniques including selective thrombolysis with good clinical effect.